Provider Demographics
NPI:1831978980
Name:ROBERTS, HOLLIE (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 TOM MCBRIDE RD
Mailing Address - Street 2:
Mailing Address - City:WALLING
Mailing Address - State:TN
Mailing Address - Zip Code:38587-6122
Mailing Address - Country:US
Mailing Address - Phone:931-260-2245
Mailing Address - Fax:
Practice Address - Street 1:2000 EAST PARIS SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:844-854-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician